Laurie Morgan is senior consultant and partner at Capko & Morgan. Her practice management consulting work focuses on operational excellence, revenue capture and the effective use of technology. Her recent title, “The People-Profit Connection: Smarter Staffing for Practice Profitability,” focuses on how the right staff using the right technology can elevate practice productivity, profitability and patient service.

“Employee engagement” is one of those squishy-sounding management concepts that sounds like it’s probably a good idea, but maybe not a top management priority. It sounds a bit like a fancy term for morale—but if that’s all it is, why all the hype about it?

Laurie Morgan, senior consultant and partner at Capko & Morgan

Engagement actually goes much deeper than happiness or job satisfaction, according to experts. After all, employees can be quite happy without working hard or productively on behalf of the organization, explains Kevin Kruse, author of Employee Engagement 2.0, in Forbes. Engagement goes beyond job satisfaction. Engaged employees aren’t just contented with their jobs; rather, they’re committed to their organizations in an emotional way. That commitment translates to what Kruse calls “discretionary effort” – i.e., taking the initiative to go above and beyond the requirements of the job description. That sense of connection and responsibility for the success of their employers makes engaged employees much more valuable.

Happy patients not only keep coming back, they also recommend your medical practice to their friends and family members.

It’s no surprise, then, that most medical practices are looking for more effective ways to measure, understand and improve the patient experience. Many healthcare organizations are taking a lesson from other industries that rely on the Net Promoter Score, a simple tool that gauges how loyal customers (or patients) are to a service or product.

Fred Reichheld, a fellow at Bain & Company, first introduced the Net Promoter Score* in a 2003 article in the Harvard Business Review. By analyzing customer feedback and purchasing data, Reichheld demonstrated a correlation between the Net Promoter Score and growth. Across numerous industries, those companies with strong customer relationships grew faster than competitors with weak customer relationships.

The Net Promoter Score revolves around this basic question: On a 0-10 scale, “How likely is it that you would recommend (a given company or medical practice) to a friend or colleague?” Based on those ratings, customers (or patients) are divided into three categories: “Promoters,” or most loyal customers with ratings of 9-10; “passives” with ratings of 7-8; and “detractors” with ratings of 0-6.

Net Promoter Score is calculated by subtracting the percentage of detractors from the percentage of promoters, leading to a highest score of +100 (all promoters) and lowest score of -100 (all detractors).

According to Jason Barro, a partner at Bain, the Net Promoter Score is useful for medical practices because it helps them understand “whether their patients are happy and loyal and it why they are getting or losing business.”

In fact, Barro and other experts cite numerous reasons why practices should not only pay attention to their Net Promoter Score but should also incorporate it into a systematic effort to improve patient loyalty and the patient experience.

More than one in two Americans cope with a chronic disease, such as diabetes, hypertension, asthma and heart disease. And 75 million Americans have two or more of these ongoing and often incurable conditions. The costs of treating chronic diseases are enormous—more than $2 trillion annually—and chronically ill patients often struggle with fragmented care.

Beyond the countless initiatives aimed at containing costs and improving health outcomes for those with chronic diseases, what simple steps can medical practices take to improve the care experience for their complex, high-needs patients?

Laurie Morgan, senior consultant and partner at Capko & Morgan

To find out, I talked to Laurie Morgan, a senior consultant and partner at Capko & Morgan who advises medical practices on operational excellence, revenue capture and the effective use of technology.

Maureen: When it comes to improving the patient experience for those with chronic diseases, where should practices begin?

Laurie: My first recommendation would be to focus more on the human touch. These patients are often scared and overwhelmed, they’re in pain and they have to make frequent trips to the doctor.

Prioritizing a more personal touch isn’t easy, especially in practices that treat a large number of chronically ill patients. Such practices are typically very busy and their staff often doesn’t have the bandwidth to pay close attention and answer patients’ questions. Luckily, there are technology solutions now that can remove some administrative burdens and give staff more time to make patients feel welcome and address their concerns.

But even simple things, such as greeting a patient who comes in frequently by name or listening intently to a patient’s questions, go a long way.

It’s no secret that people are spending more and more of their time on social media sites, sharing everything from vacation selfies to political opinions to photos of last night’s lasagna. But what about social media rules at your own practice? Do your employees understand the consequences of inadvertently or intentionally sharing sensitive patient information? Are they familiar with patient privacy rules? Do they know whether they’re allowed to be on social media while on the clock, or which sites are off-limits at work?

Ericka Adler, Partner, Roetzel &Andress. Photo by Andrew Collings.

If your practice doesn’t have a clear and defined social media policy in place, the answer to those questions is probably a resounding no, says Ericka Adler, a healthcare attorney and partner at Chicago firm Roetzel & Andress.

According to Adler, having a social media policy that educates employees, sets expectations and outlines consequences is important for practices of all sizes.

“Every group should have a policy, or at the very least a detailed discussion,” she said. “Exposing patient information is a huge liability concern, and you can’t just assume employees understand that. “Staff operate better with rules, and a good social media policy gives them those rules.”

Americans with private health insurance have seen their total out-of-pocket healthcare costs rise steadily during recent years, according to a study published Monday in JAMA Internal Medicine.

The study, conducted by researchers at the University of Michigan, found that the nation’s overall heath spending increased 2.9% per year between 2009 and 2013. Patients’ out-of-pocket costs for hospitalizations, on the other hand, jumped 6.5% each year, totaling a 37% increase in out-of pocket hospital costs during the five-year study period.

“I think the increases are very significant given this is a period of low health-care inflation and stagnant wages,” Larry Levitt, a senior vice president at the Kaiser Family Foundation, told the Washington Post. “It’s really about finding the right balance between out-of-pocket costs that don’t discourage people from getting care they need, but also don’t encourage people to use care that is maybe wasteful. I think we are — as a society, we’re struggling to find the right balance.”

Deductibles rose 86% and coinsurance costs increased 33% from 2009 to 2013, according to the study.

The research comes as the number of Americans enrolled in high-deductible health plans continues to grow. Nearly 50% of workers are covered by a plan with a deductible of at least $1,000 for individual coverage, according to survey data from the Kaiser Family Foundation. Almost 90% of the plans offered in the Marketplace are considered high-deductible plans.

The number of patients with high-deductible insurance plans is rising fast, and physicians need to have the right skills and processes in place to manage such plans effectively, according to an article in Medical Economics.

Although it’s still unclear to what extent high out-of-pocket costs can cause patients to delay care, research shows that the effect is real. According to a 2015 Commonwealth Fund report cited in the article, two out of every five adults with high-deductible plans reported limiting their care in some way.

Physicians should implement a standardized way of routinely asking patients about financial hardships, and they should document those conversations in the medical record, experts advise.

Peter Lee, executive director of Covered California recommends explaining to patients that postponing care can result in much larger medical bills and far more serious health issues later on.

For example, a patient with diabetes might be reluctant to return for quarterly foot exams at more than $100 per office visit, he says. On the doctor’s part, it’s worth an attempt to explain that a little money invested upfront in office visits ideally will avoid landing in the hospital with a painful and costly foot amputation, Lee says.

Robin Scott doesn’t mince words when describing the challenges Virginia Cardiovascular Specialists used to face when it came to eligibility and benefits. The practice’s harried front desk staff, burdened with myriad other responsibilities, would often wait until the very end of the day to double check insurance referrals and verify eligibility for the following day’s appointments. Many times, it just didn’t get done.

“They had so much going on, and it wasn’t a high priority,” said Scott, business office manager of the 38-provider, multi-site practice. “We were only getting it done about 40 to 50% of the time, and that had a direct effect on payment. Our primary denial was insurance termination–we left so much money on the table.”

Then a year ago, just after implementing Phreesia, Scott and the practice’s leadership had an idea. Because Phreesia now automated so many of the tasks that the front desk had been performing, the practice realized it needed less staff. But VCS didn’t let those employees go. Instead, they centralized electronic E&B within the practice’s business office, charging three former front-desk staff—now called E&B coordinators—with checking for missing referrals and managing denials in advance of patients’ appointments.

It’s time once again for our weekly wrap, a collection of interesting healthcare news, analysis and insightful commentary from across the web. If you see an eye-catching news story or a juicy, stats-filled report that you think I should include in the weekly wrap, please email me at mmckinney@phreesia.com.

A study of nearly 35,000 online reviews of physicians nationwide has found that customer service is patients’ chief frustration, not physicians’ medical expertise and clinical skill.

The study, published in the current issue of the Journal of Medical Practice Management, reveals that 96 percent of patient complaints are related to customer service, while only 4 percent are about the quality of clinical care or misdiagnoses.

In summary, the study found that fewer than 1 in 20 online complaints cite diagnosis, treatments and outcomes in healthcare as unsatisfactory, whereas more than 19 of 20 unhappy patients said inadequate communications and disorganized operations drove them to post harsh reviews.

“The nearly unanimous consensus is that in terms of impact on patient satisfaction, the waiting room trumps the exam room,” Ron Harman King, co-author of the JMPM article and CEO of Vanguard Communications, a marketing and public relations firm for specialty medical practices, said in a prepared statement.

“Our study uncovered a torrent of patient allegations of doctors running behind schedule, excessive waiting time to see a provider, billing problems, indifferent staff and doctors’ bedside manners. Yet hardly anyone had a beef with the quality of healthcare received.”

Mr. King noted that the absence of dissatisfaction with physician skills per se means practices should be able to improve online reviews comparatively easily.

“Generally, it’s far simpler to fix problems at the front desk or physician scheduling than to deal with allegations of inadequate medical skills. Of course, this requires a commitment from doctors to stick to schedules, allowing for only occasional urgencies that interrupt a physician’s day,” he added. (Read more)

It’s Friday and that means it’s weekly wrap time once again, when I bring you some of the week’s most interesting healthcare news and analysis from across the web. If you see a great story that you think I should share on the blog, please email me at mmckinney@phreesia.com.

Patient surveys are vital barometers of physician performance and patient satisfaction with the practice. Periodically asking patients to tell you the truth about your practice via a survey may result in a painful reckoning with reality, but self-awareness can spark improvements that are hard to achieve without constructive feedback.

Many primary care physicians don’t ask patients what they think of the practice, and others who do ask often fail to get actionable feedback. Yet every doctor with a desire to excel and a goal of offering patients high-quality care and service should be doing this at least twice a year, experts maintain.

“Customer service is our lifeblood,” says Kenneth T. Hertz, principal consultant at the MGMA Health Care Consulting Group, who is based in Roanoke, Texas. “Without customers—without patients—there’s not much of a medical practice.” (Read more)

Let’s say for a moment that you’re lucky enough to have a time machine (and a particular interest in the healthcare system). You punch in the year 2021 and speed forward through time, glimpsing first-hand how healthcare has transformed itself in five years’ time. Have population health management efforts borne fruit? Are providers working in well-organized teams? And perhaps most interestingly, what does the patient experience look like?

Dr. Don Wreden, senior vice president for patient experience at Sutter Health, a non-profit healthcare system based in Northern California, doesn’t have a time machine but as he assured me, he’s always thinking about what the healthcare system of the future might look like. Dr. Wreden was named to his role in 2015 as part of an organization-wide effort to redesign Sutter Health to be more patient-centered and responsive.

I was fortunate to speak with Dr. Wreden about promising innovations in the field of patient experience, as well as his predictions for the future.